The World Bank said the HIV epidemic in Nepal is ''somewhat similar in character to that observed in parts of India.'' ''HIV and AIDS can pose a serious economic and social development risk to countries in South Asia, including India unless prevention programmes, targeting vulnerable groups at high risk of infection, are scaled up,''a World Bank report released today said. Although surveillance in Nepal is limited and has been disrupted by political unrest, the epidemic appears to be more severe than recognised, the report observed.
''It is somewhat similar in character to that observed in parts of India and it appears to have the potential for a significant epidemic among vulnerable groups at high risk, especially sex workers and injecting drug users,'' it added.
The report said HIV responses in Nepal have been hindered by instability. Actions to date have mainly been led by NGOs. Nepal requires more urgent assistance to tackle its HIV epidemic than any other country in South Asia.
The report, titled 'HIV and AIDS in South Asia: An Economic Development Risk,' argues that, even if the overall prevalence rate is low (up to 0.5 percent), there is high and rising HIV prevalence among vulnerable groups at high risk for HIV infection, including sex workers and their clients, and injecting drug users and their partners. Overall, the number of people living with HIV and AIDS in South Asia is about 2.6 million, of whom the lions share is in India. AIDS accounts for 1.5 per cent of all deaths in South Asia and about 2 per cent of all deaths in India. These deaths are comparable to the numbers from diabetes, tuberculosis, and measles.
The report finds the impacts of HIV and AIDS in South Asia on the aggregate level of economic activity to be small. For India, the effect on GDP (0.16 per cent) corresponds to a one-off loss of about 1.5 weeks of GDP growth. However, the direct welfare costs of increased mortality and lower life expectancy are more substantial, accounting for 3 per cent to 4 per cent of GDP in India and Nepal, respectively. ''Even in the low HIV prevalence countries of South Asia, there cannot be any room for complacency,'' the report quoted Mariam Claeson, World Bank HIV and AIDS Coordinator for South Asia as saying. ''While the impact of HIV and AIDS on economic growth is small in South Asia, the welfare cost on households is by no means negligible. HIV and AIDS also have an enormous disproportionate impact on vulnerable and often marginalised people at highest risk of infection, and on poor households with less access to information, preventive services and treatment.'' The economic impact on individual households affected by the disease is substantial, the report said. In a household study on India, 36 per cent of people living with HIV and AIDS who were able to retain their employment nevertheless reported an income loss, which averaged about 9 per cent. Among those who lost their employment (about 9 per cent), the income loss was severe, at about 66 per cent. Many of the adverse development impacts of HIV and AIDS arise from its uneven impact on different population groups. Access to prevention and treatment, for example, is strongly linked to socioeconomic factors such as gender, education, and wealth. ''This analysis shows that failure to contain the epidemic at low levels may have serious economic consequences,'' the release quoted Sadiq Ahmed, World Bank Acting Chief Economist as saying. Access to antiretroviral treatment (ART) is low in South Asian countries, even compared to countries in other regions with much higher infection rates. The report says the fiscal cost of treatment could be very high if South Asian countries fail to contain the epidemic. Access to effective treatment is vitally important to mitigate the health and economic impacts of HIV and AIDS, the report added. At the same time, the medical costs of treatment can put a substantial proportion of the population living with HIV and AIDS at risk of poverty, especially in a region where most health services are paid for out of pocket. This underscores the crucial role of effective prevention.